Infection After Hip Replacement
Infection after hip replacement may involve the skin and wound or extend deep around the implant. Deep periprosthetic joint infection is uncommon but serious because bacteria can attach to implant surfaces and form biofilm. Persistent wound drainage, increasing redness, worsening rest pain, fever, chills or sudden loss of function requires prompt assessment.
For the principal treatment page, read Total Hip Replacement in Mumbai.
Quick Answer
Normal early recovery can include bruising, warmth and swelling, but the overall trend should improve.
Persistent drainage, pus, spreading redness, increasing pain or systemic illness should not wait for a routine visit.
Fever may be absent, particularly in low-grade or late infection.
No single blood test or scan can confirm or exclude every infection.
In a stable patient, aspiration and cultures are often obtained before antibiotics because prior antibiotics can reduce diagnostic yield.
Superficial Wound Problem Versus Deep Infection
A stitch reaction, small blister or superficial irritation is not automatically a deep infection. Deep infection involves tissues around the implant and may present with drainage, increasing pain, stiffness, swelling, loosening or a sinus tract. Persistent drainage or deterioration requires examination rather than repeated reassurance.
Early, Delayed and Late Patterns
Early infection may cause wound breakdown, pus, spreading redness, increasing pain, fever or delayed progress. Low-grade infection may cause unexplained persistent pain, stiffness or recurrent swelling without dramatic redness. A previously well-functioning hip can become painful after bacteria enter the bloodstream from another infection.
Warning Signs
Persistent or increasing wound drainage, pus or wound opening.
Spreading redness, warmth or swelling.
Increasing rest pain after initial improvement.
Fever, chills, confusion or systemic illness.
New pain or loss of function in a previously stable replacement.
How Infection Is Investigated
History, examination and blood tests
Assessment reviews the operation date, wound course, pain trend, prior antibiotics, recent infections, diabetes, immune suppression and previous joint infection. C-reactive protein and erythrocyte sedimentation rate can support assessment, but normal values do not exclude every low-grade infection and elevated values do not prove implant infection.
Imaging and aspiration
X-rays assess component position, fracture, loosening and bone loss; early infection may have normal X-rays. When deep infection is suspected, aspiration may assess synovial white-cell count, differential and cultures. In a stable patient, aspiration is usually planned before antibiotics because antibiotics can suppress organisms and complicate culture interpretation.
Diagnostic criteria
Diagnosis uses a combination of clinical findings, blood tests, synovial tests, cultures, histology and operative findings. The EBJIS definition uses unlikely, likely and confirmed categories to reflect that infection is not always a simple positive-or-negative diagnosis.
Why Cultures Can Be Difficult
Previous antibiotics can reduce culture yield.
Low-virulence organisms may grow slowly.
One positive sample may represent contamination.
Culture-negative infection can occur.
Treatment Pathways
Selected acute infections with stable, well-positioned components and suitable soft tissue may be treated with debridement, exchange of modular parts and targeted antibiotics. Selected patients may undergo one-stage revision. Chronic, complex or difficult infections may require two-stage revision. Suppressive antibiotics, resection arthroplasty or another salvage pathway may be considered when reconstruction risk is high or eradication is unlikely.
Antibiotics alone usually cannot eradicate a mature deep biofilm infection in a medically fit patient without addressing the implant. Read Revision Hip Replacement in Mumbai and Hip Replacement Second Opinion in Mumbai.
Risk Reduction
Optimise diabetes, nutrition, anaemia and medical conditions.
Reduce and stop nicotine use where possible.
Treat active infections and significant skin problems before elective surgery.
Follow wound-care instructions and report drainage or worsening pain early.
Avoid self-starting leftover antibiotics or applying unapproved creams.
Dental Procedures and Antibiotics
The 2024 AAOS guideline does not support routine antibiotic prophylaxis before every dental procedure for every patient with a hip or knee replacement. Decisions should consider the procedure, timing, patient risk factors and discussion between the dentist and orthopaedic team. Active dental infection should be treated, while unnecessary antibiotics can cause adverse effects and antimicrobial resistance.
Robotic Assistance and Infection Risk
Robotic assistance may support planning and component positioning. It cannot eliminate infection, biofilm, wound problems or the effect of medical risk factors. Infection prevention depends on the entire perioperative pathway.
When to Seek Urgent Help
Contact the surgical team the same day for drainage, pus, increasing redness, worsening rest pain, fever or new loss of function.
Seek emergency care for severe illness, confusion, fainting, rapidly spreading redness, chest pain, sudden breathlessness or collapse.
Questions Patients Commonly Ask
Can a blood test alone confirm infection?
No. Blood markers are interpreted with symptoms, examination, aspiration, cultures, imaging and sometimes operative findings.
Should antibiotics be taken before aspiration?
In a stable patient, cultures are often preferred before antibiotics. Emergency treatment should not be delayed in a severely unwell patient.
Does every infection require two-stage revision?
No. Debridement with retention, one-stage revision, two-stage revision and other pathways are selected according to timing, organism, implant stability, soft tissue, bone and patient health.
Clinical References
AAOS Clinical Practice Guideline: Diagnosis and Prevention of Periprosthetic Joint Infection
EBJIS definition of periprosthetic joint infection
IDSA Clinical Practice Guideline: Prosthetic Joint Infection
2024 AAOS/AAHKS Dental Procedures and Implant Infection Guideline
About Dr. Mayur Rabhadiya
Dr. Mayur Rabhadiya is an Orthopedic and Joint Replacement Surgeon in Mumbai. His hip practice includes diagnosis-led assessment, primary and revision hip replacement planning and robotic-assisted planning in selected cases. Suspected implant infection is evaluated using clinical findings, investigations and a culture strategy before treatment is selected. Qualifications: MBBS, D’Ortho, DNB (Orthopedics), MNAMS (Orthopedics), FIJR (Robotic & Navigation). Read his professional profile.
Written and medically reviewed by Dr. Mayur Rabhadiya. Last medically reviewed: 17 July 2026.
Book a Hip Consultation
For severe illness or rapidly worsening symptoms, seek emergency hospital care. For suspected infection, persistent wound problems or second-opinion assessment, consultations are available in Ghatkopar East and Ghatkopar West, Mumbai. Call or WhatsApp +91 84249 03913 or +91 96113 30063, or use the orthopedic appointment page. Bring operation notes, implant records, prior cultures, antibiotic history and imaging when available.
Medical Disclaimer
This guide provides general patient education and does not replace urgent examination, cultures, aspiration, infectious-disease input or personalised surgical treatment. Suspected deep infection requires prompt orthopaedic assessment.